多発性骨髄腫患者に発生した腸管壊死を伴わない門脈ガス血症の1例

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  • A CASE OF HEPATIC PORTAL VENOUS GAS WITHOUT BOWEL NECROSIS COMPLICATED WITH MULTIPLE MYELOMA

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A 74-year-old woman was admitted to the department of cardiology in our hospital because of sudden onset of abdominal pain. Abdominal ultrasonography (US) revealed gas running through the portal vein. Computed tomography (CT) of the abdomen showed massively edematous intestine and portal venous gas (PVG) in the liver. An emergency laparotomy was carried out because intestinal infarction was suspected. On operation, no necrotic bowel was found and a part of the jejunum between 40 and 80cm from the Treitz ligament showed marked edema and subserosal hemorrhage. The mesenteric vessels were completely patent. Intestinal resection was not indicated because the diseased jejunum was thought to be viable. Hepatic PVG disappeared on postoperative US and CT studies. Despite the improved abdominal condition, the patient went into severe renal and cardiac failure. During scrutiny, bone marrow aspiration revealed that she had multiple myeloma. Amyloidosis complicated with multiple myeloma might be a cause of organ failure. She died of cardiac failure on the 19th postoperative day. It is reported that gas of the bowel lumen escapes into the portal circulation through injured mucosa. Although the cause of PVG in this case is still unclear, underlying bowel amyloidosis might cause mucosal injury contributing to PVG. Hepatic PVG without bowel necrosis is rare. To our knowledge, no case of PVG complicated with multiple myeloma has been previously reported.

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